Christy’s Thoughts

As our practice is evolving, Jenni and I are helping more people learn how to chart their menstrual cycle. This is a skill I think everyone who has a uterus and ovaries should learn how to do. It can help you know when is the best time to conceive a baby if you are trying to, and, conversely, not conceive if you are trying not to. Fertility charting has many names: cycle monitoring, natural family planning, and menstrual tracking, just to name a few. I have a fantasy that every middle school kid learns this skill to help them know their bodies better and feel like they have some control before and as they start to experience their sexuality.

A normal menstrual cycle length is 21-35 days, with 28 days being the average. It is measured from the first day of bleeding (cycle day 1) to the first day of the next bleeding. The menstrual cycle is regulated by hormones produced in the brain and in the ovaries. These hormones fluctuate throughout the cycle causing many signs for us to notice; signs that can tell us if our cycles are healthy and when we are most likely to conceive a pregnancy during ovulation. There are several different things to pay attention to during the cycle to help interpret the signs of ovulation. We encourage people to pay close attention to their basal body temperature upon waking first thing in the morning, their cervical mucous consistency and the look and feel of their cervix (yes, it changes!), and the rise in the luteinizing hormone (LH) in their urine (often referred to as ovulation predictor kits, or OPKs). We have been using these three clues to help people figure out when the best time to conceive by insemination or intercourse might be.

There are many great books about cycle monitoring that give thorough explanations of all the signs to watch for while cycle tracking, please see descriptions in resource list below. These books have charts showing how to read temperature variations throughout the cycle and share some of the other physical and emotional changes to notice during ovulation. The Beautiful Cervix project online has great pictures to compare with if you are viewing your cervix using a speculum, as some people choose to do.

To help people track their cycles, Jenni and I created a chart for our clients to use. Please feel free to download and use this chart for yourself. MB Fertility Chart

Other Resources

Period Repair Manual by Lara Briden, ND

A new book I just discovered. The author does an amazing job describing the hormones and their functions in the reproductive and endocrine systems and outlines specific ways to “fix” your cycle if it has strayed from normal.

A New View of a Woman’s Body by the Federation of Feminist Women’s Health Centers

This older (1995) book is a fabulously detailed yet accessible book to have. Very do-it-yourself, and the illustrations and pictures are really good.

Taking Charge of your Fertility by Toni Weschler, MPH

This is an extremely thorough delve into cycle monitoring, get to learn so much that you didn’t know you didn’t know about your fertility cycle. Their website has lots of information as well.

Honoring Our Cycles by Katie Singer

I love this very simply explained way to watch for fertility signs; this is a great book with lots of pictures and charts.

A Cooperative Method of Natural Birth Control by Margaret Nofziger

An old classic, first published in 1976. This was the book I first used to learn about natural family planning when I was younger; it was the only book I could find on the topic!

Many of the above books are written with heterosexual people in mind as the target audience. They are filled with great information, but if you would prefer less hetero-normative or gendered language, check out the fertility sections in these books and the following online resources:

The New Essential Guide to Lesbian Conception, Pregnancy & Birth by Stephanie Brill

The Ultimate Guide to Pregnancy for Lesbians: How to Stay Sane and Care for Yourself from Pre-conception through Birth, 2nd Edition by Rachel Pepper

This week two things happened that made my heart sing; there were actually more heart singing moments but these two stick out regarding my work as a midwife.

The first was this:

Meira turned two years old this week ! I helped Meira’s mom at her birth two years ago and now they are expecting a sibling in a few months. It’s so fun watching families grow, not only in number of children but watching the babies I caught grow so much during their parent’s next pregnancy is very heartwarming. Speech and motor development is fascinating to watch month by month during prenatal visits. And the transition from being the baby to being big sister, though usually challenging for everyone involved, is also sweet to see from an outsiders perspective. Happy Birthday Meira!

Second was this:

We had great group of moms at our Group Postpartum Gathering. The weather wasn’t great but so many of our late summer, early fall babies brought their moms to our office for a sweet time together. There is nothing a new parent needs more than hang out time with other parents and babies! These ladies had a lively discussion and shared tips and ideas that are working for them in caring for their new little ones. Dr. Karen Rayne also came over to talk about relationships and sex after having a baby- a topic not often discussed in our culture, but one that everyone has questions and concerns about. I am hopeful that these mothers continue to feel supported in their parenting and continue to rely on their intuition and curiosity in caring for their babies into childhood. And I am hopeful I will continue to see them and watch both the mothers and the babies grow.

It is said that summer is the time of year for expansion: spending time outdoors, hot weather, lazy no-school days, water play…..as opposed to a time of contraction during the winter when it is cold and we stay inside more. In Austin, the summer seems to be a bit of both, which certainly proved to be true for us; we welcomed a new little being into our home this year, expanding our family and nestling in at home during the hottest months. Jenni went into labor just a few weeks after climbing to the top of Enchanted Rock and just a few days after she posted about being pregnant as a midwife. Now we have a thriving, smiling 2 month-old baby named Haven Otter, who is bringing so much delight to all the members of our family. Haven has created space for us to be present and connected in the midst of our very full lives. With him around, we are not inclined to be busy all the time because he reminds us to sit and hold him and stare at his cuteness. I really appreciate this part of parenting a newborn, the constant reminder to just be. I have started sitting in my front yard swing again with Haven in my lap, something I did often when my other two children were little but the habit quickly disappeared as they got older. Jenni has blossomed into a powerful and sweet Mama Bear, something awe-inspiring to witness on a daily basis. As we are settling into being two working moms with a baby, two teenagers, and a farmette, I have intense feelings of gratitude for our families, our friends, and the wonderful families we work with who create an even larger family of friends as the years go on.

Haven is not the only baby born around us this summer. We have had a busy late July and August, welcoming several other babies into their families; each entering the world with bright eyes and loving parents.

Here are few pictures of some of the new little ones:

Valor

Lucas

Isaac

Have you noticed a summer baby trend?….all boys !

We are planning to continue Group Prenatal Sessions on the first and third Thursdays of each month this fall. Here’s a look at the upcoming topics. If you are a client and have a topic you want discussed, please let us know.

A few days ago, Karen come over to our house to chat about her book, we also fed her some delicious baked pears…it’s always nice to feed someone when you really want them to talk! The following is a paraphrased retelling of our conversation….

Jenni: Is the book an accumulation of teaching classes for middle school or is it more related to the individual counseling you do?

Karen: This book is not content oriented at all, it is really about helping parents become familiar with their own feelings around sex so that they can be open to discussions with their teens in an authentic way. I discovered there is much less information out there in the literature about practically addressing your (parents’) own issues.

Christy: My sense is that a parent’s ability to talk to their children and/or teens about sexuality depends mostly on relationship building throughout parenting. It is a gradual process of becoming more and more comfortable discussing things that feel very intimate.

Karen: The context of the relationship is really important and coming to the conversation without any of your own baggage around what is going to happen in the context of that conversation is very important. There are kids who actively come to a conversation about sex and want to engage with their parents and there are some kids who absolutely do not want to talk with their parents about sex. But the ways that the parent should approach each of these kids is within the same framework of honoring and trusting your kid to bring you what they need. They may bring you the need for lots of discussion about sex or none at all; the important thing is to remain open to the dialogue however much or little that is.

Christy: I have been amazed over the years when I didn’t think my kids were listening, I later learned they were taking everything in and remembering it!

Karen: That’s something I do talk about it in the book a lot, about how much your kids do listen to you and how well they do know you. By the time they are teenagers, they really know you AND your reactions very well. Now it is your time, as the parent, to listen and get to know them really well. It’s important to spend a lot of your time listening and really hearing what they are saying, being a sounding board for them to process and assess where they are, thus helping them move forward in beautiful ways.

Christy: What came to me listening to you just now is that we can and should give our kids credit for knowing more and being capable of figuring things out more than we might think.

Karen: It’s a transition, right. When our kids were three, we clearly knew more things about their bodies and how they work and what their needs might be, but as they get older it’s a process of them learning and knowing their own needs; the adolescent years are when this self knowing and transfer of power happens most dramatically. In many ways our culture sees it as a lack of innocence if you know about sex, and even if you don’t buy into that it can be a little bit shocking when your kids start to talk about sex. Cards Against Humanity is a really interesting point of discussion around this. Most of my high school students have played it and some of my middle school students have.

Christy: I feel like middle school age is a little inappropriate for playing Cards Against Humanity but I actually think it would have been a great game for me to play in high school. I was so naïve and broadening my world would have been helpful, I think; shocking and a little embarrassing, but helpful. So I have not tried to stop my high schooler from playing it, but I have encouraged my middle schooler to wait till she gets a little older.

Brief digression here but moving on….

Karen: Kids do generally think their parents are stricter than they are. And I think this comes from a place of kids really, really caring what their parents think. Especially with something like sex, kids may think their parents are particularly less open-minded than they are. Take my classes for example, some of my students say, “my parents would never be OK with me talking about this.” And I say, “well, your parents know the entire curriculum for this class and they pay me a lot of money to discuss this stuff with you!” And they say, “ooo….”

It’s like an impulse or reflex that the students respond this way to some of the things we talk about in class. So what I am trying to do with the book is to help parents help their kids get out of that reactionary place by suggesting that they [the parents] stay interested in what their kids are saying and engaged with their kids at whatever level the kids are bringing the conversation to. This will help the kids understand that their parents really want to be there with them, listening to their thoughts, emotions, and feelings, considerations and worries, instead of the parent leading the conversation. It’s a definite conversation power shift that helps kids discover their own sexual paths.

Jenni: That speaks to the individuality of sexuality, that we are all dramatically different from each other, so that makes a lot of sense to me.

Karen: I think there is an element of kids needing to separate from their parents in some way, and sometimes they tell the parent and sometimes they don’t. Every kid in my class talks about their parents. It’s like their parents are over their shoulder, there with them. Sometimes the kids are arguing with them, sometimes agreeing, sometimes trying to figure their parents out, but they are always there, figuratively present with the kid. It’s about how as a parent to be supportive of their kids finding their own identity, whether this matches what the parents want or expect.

Jenni: Even when you may not have figured it out for yourself… (laughter)

Karen: Yes, and that’s what the first four chapters in the book are about, the parent figuring themselves out enough to be present in the conversation about sex with their kids.

Seeing as we are midwives who get lots of questions about sexuality and relationships, our discussion with Karen moved along to sex during pregnancy and the postpartum months. She facilitated one of our group prenatal sessions last year, and talking about that experience is where this conversation picks up again…and then organically moves back to talking with kids, very cyclical….

Christy: People expect their sexuality and sex drive to remain the same in pregnancy and postpartum and most often it does not. That change can be pretty sudden and can catch both partners off guard.

Jenni: And then there is this notion that when people become pregnant they have to put aside their sexuality and/or some people have trouble figuring out how to be a parent and a sexual being at the same time.

Christy: Yes, when one has a lot of different hats to wear it’s hard switching back and forth between them quickly.

Karen: What’s normal? What’s right? I think that is where people’s questions really are. People have a fear of cross-mingling sex and babies/children.

Christy: I also think one thing pregnant people are really surprised by is how low their libido is in pregnancy and/or the postpartum months. Some people worry, I think it’s a common fear, that they will never feel like having sex again in the way they did before having a baby. I think it is totally normal and it’s a helpful thing to point out that they may not have sex for a very long time but that the desire will come back. Of course, some people have a very high libido in pregnancy and enjoy it very much! I want to help people understand that libido is very fluid over a life span; sex drive varies greatly at different times in people’s lives. That’s something I don’t remember hearing about or talking about when I was pregnant or just postpartum: that sexual desire is so up and down over one’s lifespan.

Karen: I think that is one thing that is really missing in abstinence-only sex education. So when we are talking about abstinence in my classes with young people, I always say to them that there are times over their entire lifespan that they will be deciding not to have sex, for a variety of reasons — maybe they don’t have an appropriate partner, they or their partner may have some kind of STI, they may have other physical health concerns, maybe they’ve just given birth to a baby, there are lots of reasons, they may be on a spiritual journey where refraining from sexual contact is what seems best at the moment… During their life, whether they’re married or not, whether they have a partner or not, there will be times in their life when they will choose to refrain from having sex… Really honoring the space that abstinence provides is something not just for teenagers; because, firstly, I think that teenagers can hear it more easily if it’s something for everyone, and also they are then able to carry that into their future lives where they are able to respect a decision or feeling inside themselves to refrain from sexual activity. It’s important for people to know that choosing abstinence at all different times in their life is a respectable decision and a respectful decision as part of the life process.

Christy: I think that the common approach to abstinence only birth control does teenagers a big disservice. This description you give providers a more holistic view of what abstinence can look like in an empowering way.

Karen: When coming to a conversation with your kids about sex, the key is to identify your own issues so that even if you don’t resolve them, you at least know what they are, and if your kid starts to mention something [difficult for you], you know where the trigger is coming from. This will help you know when to take a break in the conversation, because you’re having a reaction that’s about you and not about them. But part of that process is ideally learning to just sit with where you are sexually at any given moment. It may be a time of a lot of arousal, and a lot of desire, and a lot of sexual activity, and a lot of orgasms, or it may be just a place of a lot of desire, but not a lot of arousal or sexual activity. There are a lot of variables at play here, and I think that just letting your body whisper to you where you are and following it and respecting it, and not feeling the need for it to be different is a huge gift to yourself and for your kids. The painful parts of sexuality are when you end up with sexual activity and even orgasm, without the arousal or the desire. That’s what we really want to avoid.

Jenni: And that can be tricky if you are partnered, with all the potential discrepancies between partners. And often, as a parent, I imagine you are trying to figure out where you are at, and that’s influenced by your current relationship or non-relationship. So then it’s influenced by your partner’s desire or interest in sex.

Christy: So, it could be that the sexual desire of both partners could go for long periods of time never matching up; that kind-of stinks. And then they have to navigate that within the relationship.

Jenni: I can imagine that affects the conversation with your kids; trying to figure out what to say to them when you are figuring out your own relationship makes it much more complicated.

Karen: So much more complicated! And if you have all these emotional reactions to sex because of what’s going on in your relationship right now, then talking to your kids about it, without having any of your own emotional reaction around the topic influencing the conversation, is really, really hard.

[Pause in conversation, which is unusual for us]

Karen: That’s how it can be talking to kids. It is a process of trying to negotiate your response, because in some ways that is a public face, rather than a private face. Your private sexual life is not about your child and they don’t need to have any part of it or know anything about it, in terms of concrete details for sure. But how do you negotiate your public face in those conversations while still being authentic, because if you’re lying your kids are going to pick up on it. You have to be honest to a degree, saying things such as “You know this conversation is really hard for me right now, but I know it’s important so we’re going to have it anyways.” Owning up to that weirdness is important. One of the things that I cover in my book is that [as a mature adult] you use the other adults in your life to talk with about sex or other issues before you talk to your kids. Work through some of your own stuff with your peers, or a therapist, or whomever is appropriate for you.

Christy: I think that’s a good place to end it, especially since our kids are such great mirrors of ourselves, helping ourselves ultimately helps them.

Yesterday we had a great discussion at group prenatal. Jenni and I wanted to pass along more information related to the topics we discussed.

We talked about the importance of helping the pelvic floor stay strong, especially after birth. My favorite information about pelvic floor health, complete with excellent pictures, great descriptions, and helpful exercises, comes from Blandine Calais-Germain. She has two books that I highly recommend, though The Female Pelvis is geared more towards pregnant clients.

We also talked about things to do to be nice to ourselves in pregnancy, ways to get out of the hustle and bustle and really connect to baby and self. This blog post from Pam England (Birthing From Within) and meditaion from Aviva Romm came to mind so we are passing them along:

The Safe Space Body Awareness meditation, from Aviva Romm, is an exercise from her article on sexual health generally as well as in pregnancy.

“Close your eyes.

Imagine that there is a soft, pink, warm bubble around us, the size of a comfortable room. In this space you are warm and protected. Everything that is said here is confidential and sacred.

Now, take a few deeps breaths. Make your mind and your belly soft. Breathe deeply and slowly, inhaling to the count of 4, imagining your breath bringing a warm, glowing, pink light all the way down into your sacred woman parts. Imagine this soft light bathing your pelvis, all the way down to your pelvic floor. Feel warmth spreading through your lower abdomen. Notice any areas where you feel tight, tense, blocked and use this light to massage them free. Then exhale to the count of 6, letting go of all the tension in your body. Quiet your mind and focus only on the rhythm of your breath and the feeling of your breath moving deeply through your body. Repeat this 8 times. There. Now open your eyes.”

Some people talked about how being pregnant just isn’t what we thought it would be, it’s hard and makes us not feel like ourselves. Again Aviva Romm’s insights to the rescue: read about Depression in Pregnancy to help stay connected to the process of becoming a mother.

Aviva’s pregnancy book has other great information, exercises, and meditations as well.

Group prenatal appointments generally happen the first and third Thursdays of each month from 10 to noon. Let us know if you want to attend in place of your individual appointment time. You can attend a group on a week by week basis; topics are determined according to a rotating schedule and the interests and questions of whomever is attending on a given day.

I have been working with the international organization Human Rights in Childbirth for about six months, getting to know the founders and feeling my way around the organizational structure. Recently, I was asked to be on the newly expanded HRiC board of directors, which I gladly accepted. HRiC’s mission and values align perfectly with my beliefs that people always have the choice to make the decisions about their care, regardless if those choices fall inside or outside the standard of care. Often what is practiced in medicine, particularly in obstetrics, is not evidenced-based or even compassionate, but rather based on efficiency, provider opinion, and “that’s just how it is done.” HRiC’s goal is to amplify the voices of people in their own communities, to network, and to share legal tools to help create change in maternity systems.

Hermine Hayes- Klein, founder of HRiC, joined with other attorneys representing Birth Rights Bar Association, Improving Birth, and International Cesarean Awareness Network, in writing an amicus curiae brief to highlight the rights of people to refuse care/interventions in the US maternity care system. An amicus brief is a legal opinion or testimony not solicited by any parties in a legal suit. In this case, these organizations wanted to bring attention to the considerable informed consent and refusal negligence seen in maternity care today, which is an under-identified violation of rights in this country. See links below for full text.

I find winter in Austin very confusing to my body (and psyche). Temperatures swing from 25 degrees to 80 degrees and back again within 48 hours, at least this winter that is how the weather is going. Our garden starts to show signs of blooming in January and then gets blasted with frigid winds from the North a few days later. And here in Central Texas where cedar trees, though not native, abound, many people sniffle and tear and cough for weeks. I thought I would write up some ways to help our bodies protect and dissuade unwanted organisms or pollen from wreaking havoc on our health. All remedies are pregnancy and child safe, of course.

Vitamin C: 1000-3000mg daily helps to boost immune system function; amounts over 1000mg can cause loose bowels in some people so adjust accordingly; Emergen-C is a great way to get large doses of Vitamin C as each packet contains 1000mg of Vitamin C plus B Vitamins and electrolytes.

Zinc: Taking 20-40mg of zinc a day in lozenges or tablets when a viral illness just starts presenting itself can decrease the life span of the virus.

Nettle tea: Drinking strong nettle tea throughout the day (1 quart) can really help decrease the bodies allergic reaction to environmental allergens including cedar and other plant pollens; steep 1/4 cup loose dried nettle leaves in a quart of water for 30 minutes or longer; strain and drink hot or cold.

Elderberry: Taken in syrup or lozenge form is great for keeping illness away; 2-3 Tbsp of elderberry syrup per day is adequate and tasty. Often elderberry syrup contains ginger which is another anti-infective plant that increases immune function.

Vitamin D: 3000-5000 IU per day helps boost the immune system; Vitamin D is a fat soluble vitamin and can reach toxic levels if not monitored adequately; it is a good idea to have your Vitamin D level checked at least yearly as many women in North America have very low levels of Vitamin D; functional Vitamin D blood level range is between 60 to 100ng/ml.

I am happy to talk with clients about sources and recipes for these products and often have homemade elderberry syrup and dried nettles available at prenatal appointments.

A few days ago I returned from Kansas City, Missouri where I attended the Coalition for Improving Maternity Services (CIMS) conference. This coalition was formed around several organization’s joint desire for evidence-based maternity practice. CIMS leaders conceived of the Mother-Friendly Childbirth Initiative, a 10 -step process designed for maternity care providers in hospital, birth center, and home birth settings to support, protect, and promote mother-friendly practices. It outlines basic human rights in pregnancy care and childbirth.

Penny Simkin, doula and teacher and over-all gentle soul, was also at the CIMS conference. She spoke about physiologic third and fourth phases of labor, the time when I think midwifery care and medical model care differ the most. This is the first couple of hours after birth when the mother’s body is figuring out how to not be pregnant anymore and the baby is figuring out how to live in a non-water-filled environment. It is a time of transition and bonding and deep emotion. It is a time for falling in love. It is a time for quietness and peacefulness and non-busy-ness. It is a time to protect the sacred space around the mother and baby together. Though Penny did not use these words specifically, I knew what she was talking about because I get to witness this time at every birth I go to. Unfortunately, the hospital setting does not usually create the same kind of immediate postpartum sacred space that a home or birth center environment can. I was happy to hear that someone as respected as Penny Simkin was talking about this in a room with many people who provide care in hospitals. It seems the more times people hear something, the more likely they are to believe and act upon it.

After the conference, when I arrived at my airport gate, I was delighted to see that Penny and I were on the same flight. We sat and chatted and shared some popcorn for nearly an hour before boarding the plane. I tried to listen and soak in as much of her sage wisdom as possible. We talked about health disparities and postpartum depression and her children and her teaching. She is truly one of our most treasured advocates for moms and babies in the country.

Science and Sensibility recently had a couple guest posts from Penny where she describes benefits of singing to your baby, both inside and outside the womb, they can be read here:

My dear friend Beth Berry has been writing a blog for a few years called Revolution from Home. I have known about it, glanced a few times, chatted with her several times about her writing… but it was not until tonight, with the house very quiet and a little heater warming my feet, that I allowed myself to delve into her thoughtful writing and beautiful pictures.

Sex Advice Columnist and co-creator of the It Gets Better Campaign, Dan Savage, signing books at the SexTalk Symposium

Earlier this week I had the delightful opportunity to attend SexTalk – A Symposium with Benefits at Southwestern University. This was one of the many wide ranging topics that the Brown Symposium series has covered over the past 30 years. Not only was the subject matter exciting, intriguing, awkward at times, and funny, the symposium was also highly educational and planned with much thoughtfulness and detail. Thanks to my dear friend Karen Rayne, unhushed sexuality educator, for cluing me in that it was happening.

You might be wondering what a symposium about sex has to do with midwifery, though if you think about it really hard you can probably come up with the answer. Sex is, afterall, often the thing that makes women pregnant. Not always, but much of the time. Giving birth, like having sex, can be a very sensual experience. I have heard more than once that babies “come out the same way they got in there.” Though this symposium was NOTHING about birth and ALL about sex, it seems very relevant to my work as a midwife. My clients often talk to me about their sex lives, good and bad, and often have questions about the physical act of sex, or the many emotions around sex and relationships.

SexTalk organizers state, “from an early age, we’re bombarded with negative messages about sex and are socialized to be ashamed to talk about it. The taboo surrounding sex is unfortunate because the benefits of increased knowledge and communication about sex are many, and the costs of not having these discussions can be dire. Although sexuality is a difficult issue to discuss, it is crucial that we do so – in our homes and in our communities – to promote sexual health and responsible behavior.”

Hats off to SexTalk organizer Traci Giuliano, professor of Psychology at Southwestern University for bringing together a great group of speakers to discuss an uncomfortable topic that everyone is interested in. The four speakers who enlightened, entertained and educated the attendees were professionals in different fields: a minister, a sex advice columnist, a sexuality educator with teens and older adults, and a sex researcher. Their messages were all related and from my viewpoint all seemed to focus on the theme of communication, communication, communication.